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Gastrointestinal bleeding refers to any bleeding that occurs within the digestive tract, from the esophagus to the rectum. It can be classified as upper GI bleeding (above the ligament of Treitz) or lower GI bleeding (below the ligament of Treitz), with causes ranging from peptic ulcers and varices to diverticulosis and malignancy.
Upper GI bleeding commonly results from peptic ulcer disease, esophageal varices, or Mallory-Weiss tears, often involving erosion of blood vessels in the mucosa or submucosa. Lower GI bleeding frequently stems from diverticular disease, angiodysplasia, inflammatory bowel disease, or colorectal neoplasms, typically involving mucosal inflammation, vascular malformations, or tissue breakdown.
Clinical presentation varies by location and severity, with hematemesis and melena suggesting upper GI sources, while hematochezia typically indicates lower GI bleeding. Initial assessment focuses on hemodynamic stability, followed by risk stratification using tools like the Glasgow-Blatchford score for upper GI bleeding. Diagnostic approach includes endoscopy (EGD for upper, colonoscopy for lower), with CT angiography or tagged RBC scan for obscure bleeding cases.
Key imaging focus: Active contrast extravasation, vascular malformations, tagged RBC scan timing